Can interoperability help connect the dots?

By John Andrews
12:15 PM

Several years into the national interoperability initiative, it’s fair to wonder if the healthcare industry is making as much progress as expected when it started under the George W. Bush administration. It’s also fair to wonder how much of a difference ARRA stimulus funds will make in fostering healthcare connectivity.
The ambitious vision of building an IT infrastructure that allows for data to be shared seamlessly between organizations has faced its share of difficulties and delays. With so much to be done, some have been overwhelmed and paralyzed with indecision. The recession has taken a serious toll on hospital IT budgets.
Skeptics have questioned the need for such an elaborate system in the first place.
Yet whatever setbacks have occurred to date, it hasn’t dampened enthusiasm or optimism from those working in the interoperability domain – the prevailing attitude is one of confidence and determination for an interoperable future.
“More so today than in years past, the healthcare industry has a firmer understanding of interoperability’s importance – especially in light of payers, providers, HIT vendors and thought leaders all passionately evangelizing about it,” said Eric Mueller, president of the Seattle-based Washington Publishing Company’s service division. “With new laws and reforms coming into the play, the opportunity to make interoperability a reality is even more prevalent.”
One emerging topic on the interoperability front is the conceptual model where “common parts” to be shared don’t necessarily require a standardized structure, as previously thought, Mueller said.
“This is an important consideration and quite possibly the next big breakthrough,” he said. “If we’re to work towards an unstructured model that enables interoperability more proficiently, our industry may be in its infancy of addressing it beyond technical design to a practical application that solves business problems. Regardless, the timing for our healthcare ecosystem to take interoperability seriously is now.”
Most users and vendors have historically approached interoperability in healthcare systems as an enterprise integration problem, said David Hartzband, chief technology officer for San Francisco-based Resilient Network Systems.
“We know from many years of experience with these approaches that they are complex to design and to deploy, and that they rarely meet interoperability and performance goals without a large and costly systems integration effort,” he said. “The way out of this ‘design and deployment’ mess is to rethink the larger interoperability problem as a network issue and to design and deploy a network-based solution.”

SaaS, HIEs & ACOs
One format simplifying interoperability is software as a service, or SaaS, said Oleg Bess, MD, CEO of Culver City, Calif.-based 4medica.
“The feverish pace of building interfaces will likely diminish as SaaS-based solutions become more prevalent in the market,” he said. “Both inpatient and ambulatory SaaS applications will likely require only a single interface to interconnect thousands of doctors to their labs and hospitals. Those SaaS applications that can be used in both inpatient and ambulatory settings have an even greater out-of-the-box interoperability, making them a perfect solution for (health information exchange) and (accountable care organization) implementations.”
Robert Hitchcock, MD, chief medical information officer for Dallas-based T-System, said HIEs have been the catalyst for healthcare organizations’ increased participation in data sharing to date.
“Information is increasingly available for the healthcare community – both within the organization and with outside entities,” he said. “However, healthcare facilities still have a reluctance to build and maintain interfaces as they are often seen as projects best to be avoided. This leads many organizations to adopt enterprise solutions that have a negative effect on operations and revenue.”
To be sure, the trend toward accountable care has the spotlight fixed on ACOs, said Ashish V. Shah, senior vice president and chief architect at Salt Lake City, Utah-based Medicity.
“ACOs are the real story driving interoperability forward,” he said. “In order to deliver on this new model of care delivery, providers need to be connected to collaborate in new, efficient ways never seen before in the United States. Three years ago, we were getting a lot of blank stares on this topic. Today, we get a lot of nodding heads and validation that technologies like ours are not just nice-to-haves, but must-haves.”
Brett Furst, vice president of healthcare for Detroit-based Covisint, said the term “interoperability” actually has a wide range of meanings.
“Interoperability can be defined as anything from the accessing of different systems and applications to the sharing of clinical and administrative information across platforms and environments,” he said. “Over the past few years, the technology has been in place to facilitate interoperability at all levels – but really, it’s more of a governance and relationship issue.”
On the upswing
Compared to several years ago, the requirements to provide interoperability have increased steadily as more clients have adopted and deployed electronic medical record systems in their practices, said Fred Ferrara, chief information officer for Palm Beach Gardens, Fla.-based Aurora Diagnostics.
“I’ve seen an industry that has widely accepted that interoperability is a requirement and one that’s only going to expand as healthcare becomes more integrated,” he said. “However, many challenges still exist in achieving the level of interoperability that is needed for optimal efficiency when exchanging healthcare information. More vendors are becoming accustomed to the need to develop interfaces from their systems to other healthcare IT systems in order to effectively meet their clients’ connectivity needs within an increasingly interconnected environment. With more than 300 EMR vendors currently operating in the healthcare space and large variations in how HL7 is implemented, there’s still a lot more work ahead before integration approaches a turnkey solution.”
Denver-based Health Language has been working with payers on interoperability, and CEO George Schwend said the insurance side is gaining the most traction.
“From what I’ve seen, payer organizations are further along in this process because they have the luxury of being able to focus without the major distraction of meaningful use compliance,” he said. “Most insurance providers understand the scope of work involved in overhauling their systems, and they are currently evaluating and purchasing interoperability solutions to enable the level of data sharing that the national push for coordinated and collaborative care requires.”
Conversely, hospitals and health systems “recognize that interoperability will ultimately be a requirement for achieving the maximum payments under meaningful use, but they haven’t been able to move forward quickly because they are addressing several simultaneous time-sensitive priorities,” Schwend said. “This explains why many providers are still in the assessment phase as they attempt to make the right vendor selections.”
Growth potential
Charles Halfpenny, chief technology officer for Blue Bell, Pa.-based Halfpenny Technologies, agrees that hospitals have many competing priorities, but said progress is continuing gradually.
“While some hospitals believe they can supply connectivity to affiliated and owned physicians, many look to outsource the establishment of connectivity to companies like us,” he said. “The demand, while large enough now, has not fully hit yet. EHR adoption in many locations is still as low as 10 (percent) or 20 percent. If the forecasts of 80 percent adoption are to be believed, we will continue to see significant and accelerating demand into the foreseeable future.”
In assessing healthcare’s overall progress with interoperability, John Kelly said the industry has made “moderate” advancements, but that there needs to be a stronger sense of unified purpose.
“There has been ongoing work on interoperability standards but because the payload transport protocols haven’t been established there is still no ubiquitous, low-cost or free network to base an active data exchange process community,” said Kelly, chief information officer for Boston-based NaviNet. “What we are doing right now is the equivalent of inventing attachments before we invent email. Without a broadly accepted transport protocol the real value of the interoperable payloads is significantly lessened. Without the free network, innovation is severely constrained by business models based upon the monetization of transport rather than applying genius to the value chain. For interoperability to be realized we need to stop thinking of ourselves as HIT vendors and start thinking of ourselves as Internet companies applying our resources to healthcare.”
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